6 Month Pet Pantry Application

Pet Pantry: 6 Month Program

Thank you for contacting Ruff Haven!
We help people care for their pets during times of crisis.
This form helps us get to know you and your pets so we can offer the right support.
All answers are confidential.

Important Information About Our Pet Pantry
- Free Pet Food & Supplies: Available to families in Utah. All items are donated and provided based on availability. They’re meant to supplement, not fully replace, your regular pet food. This is per family not per household.
- No Proof of Income Needed: If you say you need assistance, we trust you. No financial info required.
- Timeframe for Assistance: You can receive pantry support for 6 months. After a check-in, support may be extended up to 12 months total, with further help offered case-by-case.
- Spay/Neuter Requirement: All pets must be spayed or neutered within 6-12 months of starting the program. We may be able to help cover the cost.
- ID Required: You’ll need to show some form of identification. It doesn’t have to be government-issued. It can be a photo ID, a letter with your name/address, or a caseworker note.
- No New Pets: You can’t add new pets to the application during the first 6 months unless there’s a change in circumstances and it’s approved.
- Picking Up for Someone Else: We’ll need their info on file.
- Phone Intake Required: A 5-10 minute call is part of the application process. Let us know if you need a different format. We’re happy to accommodate.
PICK-UP SCHEDULE
(NOVEMBER SCHEDULE)

Thursday, November 20, 6pm-7pm

Saturday, November 22, 12pm-1pm
Tuesday, November 25, 8am-9am
Saturday, November 29, 12pm-1pm

(DECEMBER SCHEDULE)

Tuesday, December 2, 8:00 AM to 9:00 AM
Thursday, December 4, 6:00 PM to 7:00 PM
Saturday, December 6, 12:00 PM to 1:00 PM

Tuesday, December 9, 8:00 AM to 9:00 AM
Thursday, December 11, 6:00 PM to 7:00 PM
Saturday, December 13, 12:00 PM to 1:00 PM

Tuesday, December 16, 8:00 AM to 9:00 AM
Thursday, December 18, 6:00 PM to 7:00 PM
Saturday, December 20, 12:00 PM to 1:00 PM

Tuesday, December 23, 8:00 AM to 9:00 AM

Tuesday, December 30, 8:00 AM to 9:00 AM

You may pick up food once a month.

No appointment necessary; however, you will need to complete the application and intake call before picking up food.

If you walk in without having completed an intake, we will be unable to provide anything.
Applicant Information
Email Address*
example@example.com
Phone Number or Email Address (You must provide either a working phone number or email address to receive updates and reminders): Phone Number*
Address-- or provide a zip code*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please enter the number of pets you have by size:

(Note: Ruff Haven can provide food for up to 5 pets per household)
Small Dogs (e.g., under 20 lbs):
Medium Dogs (e.g., 20-50lbs)
Large Dogs (e.g., 50-80 lbs):
Extra Large Dogs (e.g., over 80 lbs):
Cats (up to 5):
Litter is not always available but we do try to provide it when it is; is this something you will need?

YesNo
Do you have any special requests for your pet(s) e.g., dietary restrictions, allergies, etc? If yes please list concerns*
Are you home-bound and require delivery? If yes, please note that delivery is available only within specific ZIP codes and for individuals unable to leave their home due to medical or health reasons with proof of being home-bound.

NoYes
Please confirm that you reside in one of the listed ZIP codes if you are requesting delivery.
Appointment Scheduling & Walk-in Information

Below is a scheduler to make an appointment for a mandatory phone call to do a 5-10 minute intake meeting that will go over resource and demographic information to better help you and your pets.
Please read and mark all boxes to indicate you understand the following:*

I understand that if I pick up food or supplies for someone else I must have them listed in the application.I understand that I can’t add any new pets to my application during the first 6 months.I understand that this program is time limited. It is an initial 6 months and can be extended to 12 months after a check in. After 12 months extensions will be given on a case-by-case basis.I understand that my pet must be spayed or neutered (fixed) to be in this program. This needs to happen within 6 to 12 months. Ruff Haven can assist and provide resources for this.I understand that I must provide some form of identification (ID, official mail, or case manager verification) with this application.I agree that I will not sell any food or supplies I get from Ruff Haven on websites like Facebook Marketplace, KSL, or other online places. If I do, I may be removed from the program.I understand that most of the food Ruff Haven gives out may come in torn or damaged bags or look a little worn.I understand that delivery is only for people who can't leave their home because of health or medical reasons and who live in the ZIP codes listed above.I understand that I am required to pick up my food and other supplies from Ruff Haven at 264 S. Glendale St. (1135 W.) in Salt Lake City on the scheduled pick-up days/times.Due to the nature of our nonprofit services and high demand, Ruff Haven reserves the right to rescind or deny any Pet Pantry application at any time, for any reason, to maintain program integrity and fairness.
Who will be picking this food up? If other, please provide the name and phone number or email of the person picking up for you:*

I will be picking it up myselfAnother applicant (please make sure they list you on their application too)Other
What is the other applicant's name?

First NameLast Name
Support/Needs Section

We ask these questions to help you and your pet in the best way we can. Your answers also help us improve our program and show funders how our services make a difference.

We will never share or sell your personal information without your permission, unless the law requires it. Your information is stored safely and kept private.

When we share information for reports, we remove your name and any personal details so no one knows it’s you.

By filling out this form, you agree that we can use your answers to help you and make our services better.
Primary Language Spoken at Home*
Race/Ethnicity*

Hispanic or Latino/a/xNot Hispanic or Latino/a/xI use a different termPrefer not to say
Pronouns Used (she/her, he/him, they, etc.)
Are you a military veteran or currently serving in the military?*
Do you identify as person living with a disability?*

YesNoPrefer not to say
What is your current housing situation?*

I have stable housing (own/rent)I’m temporarily staying with friends or familyI’m staying in a shelter or transitional housingI'm living in my car, outside or in a place not meant for housingI prefer not to answer
Are you currently receiving government assistance? (e.g., SNAP, TANF, Medicaid)*

YesNoPrefer not to say
Number of pets in your household:*
How many of your pets are spayed or neutered (fixed)?*
Do any of your pets have medical conditions or special needs?*

YesNo
If yes please describe
Which of the following services or items would help you care for your pet(s)? (Check all that apply)*

Vet care (checkups, wellness exams)Vaccinations/flea-tick treatmentSpay/neuter assistanceBehavioral or training supportTransportation assistance for pet appointmentsTemporary pet foster careNone currently
Would you like a staff member to contact you about additional services or referrals for your pet(s)?

YesNoMaybe later
Would you like help connecting with any of the following community resources?*

Food pantries or meal servicesEmergency housing servicesLow cost medical services or prescriptionsMental health services or counselingBill and rent financial supportTransportation assistanceLegal aid or advocacy servicesNone currently
Would you like a referral to local agencies or organizations that support families in crisis?

YesNoI'm not sure
Have you or anyone in your household been impacted by opioid use (including prescription or non-prescription opioids)?*

Yes, currentlyYes, in the pastNoPrefer not to answer
If yes, would you like help connecting with support services related to substance use recovery

YesNo
If you are facing other challenges or need further assistance please describe below:
Signature*

Clear
Date*

MonthDayYear
Date
For questions or additional information, please contact:

Email: petpantry@ruffhaven.org
Text: 801-613-2198

NEW ADDRESS: 264 S. Glendale St. (1135 W.), Salt Lake City, UT 84104
(General Tip: We’re just off 1100 West and 300 South in a warehouse-style building on the Jordan Parkway trail across from Franklin Elementary School.)
Please verify that you are human*
Name*

First NameLast Name
Should be Empty:

Applicant Information